Creative Evidence-Based Use of Electrical Stimulation in Acquired Brain Injury Rehabilitation

72 Pages·2015·3.95 MB·English

by  Berryman, Amy

Creative Evidence-Based Use of
Electrical Stimulation in Acquired
Brain Injury Rehabilitation
Amy Berryman, OTR, MSHSA
Denise O’Dell, PT, DScPT, NCS, MS
APTA Combined Sections
February 20, 2016
Introductions
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Convention…
adjective: conventional

1) based on or in accordance with what is generally done or believed:
"a conventional morality had dictated behavior"
synonyms: unoriginal · formulaic · predictable · stock · unadventurous · unremarkable
· humdrum · run-of-the-mill

(of a person) concerned with what is generally held to be acceptable at the
2)
expense of individuality and sincerity.
(of a work of art or literature) following traditional forms and genres:
"conventional love poetry"
synonyms: conservative · traditional · traditionalist · conformist · bourgeois · old-fashioned
· of the old school · small-town · suburban · straight · buttoned-down · square
· stick-in-the-mud · fuddy-duddy

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Question:
What is “conventional” E-Stim Use?
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Definition

Electrical Stimulation:

The use of electrical current applied through the skin
via the motor nerve to help produce a muscle
contraction.
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Neuromuscular Electrical Stimulation (NMES)

vs.
Functional Electrical Stimulation (FES)

• NMES: uses a device to send electrical impulses to nerves. This input causes
muscles to contract. The electrical stimulation can increase strength and range of
motion, and offset the effects of disuse. It is often used to “re-train” or “re-
educate” a muscle to function and to build strength after a surgery or period
of disuse but is more truly routine exercise and strengthening.

• FES: refers to the use of (NMES) or electrical stimulation during a task.
This can include walking or using an arm to reach. Foot drop is a common
problem following a neurological injury which may result in decreased walking
speed, decreased step length, and tripping. When FES is applied to the muscles
that lift the foot at the correct time during the walking cycle it may not only
impact the ability to clear the foot and improve safety when walking but may
result in increased strength of those muscles and increased range of motion at
the ankle joint. FES can also improve safety, ease, and efficiency with walking.

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Learning Objectives
1. Discuss purpose and parameters for use of
FES for neuromuscular rehabilitation.

2. Summarize current literature for use of FES
for management of impairments.

3. Review clinical cases and videos for creative
treatment application of FES.

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E Stim Basics:
Contraindications/Precautions
•Cardiac Demand Pacemaker-need MD permission
•Hx of Congestive Heart Failure-need MD permission
•Recent Myocardial Infarction-need MD permission
•De-conditioned elderly patients- need MD permission
•Pregnancy (esp. 1st and 3rd trimesters)
•Protruding metal ( staples or external fixation)
•Incision sites
•Skin abrasions
•Do not shave the skin sooner than two days before
Estim is applied. Use scissors to cut hair.

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E Stim Basics: Parameters
Clinical Neurophysiology Systematic Review – 19 studies
Peripheral electrical stimulation to induce cortical plasticity: A systematic
review of stimulus parameters
Mar2011, Volume 122, Issue 3, Pages 456-463
L.S. Chipchase, S.M. Schabrun, P.W. Hodges
• This review provides an overview of the electrical stimulation parameters
needed to induce cortical plasticity in human subjects.
• current data indicate that stimulation intensity may be an important factor
in determining the direction of rapid plastic change. In particular, there
was a trend for stimulation above motor threshold to increase excitability
of the corticomotor pathway.
• Electrical stimulation in the clinical setting is a feasible and inexpensive
application. It has been widely used although its potential for inducing
plastic change has been realized only recently.
• How ES can be used to induce clinically meaningful plastic change in
movement related disorders needs to be addressed
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E Stim Basics: Parameter Adjustment

Goal of Adjusting Parameters:

1. To achieve the most beneficial and
appropriate muscular contraction and in the
case of our presentation to achieve function
2. To maintain maximum patient comfort

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